晚期非小细胞肺癌患者在一线化疗和免疫治疗进展后进行二线治疗的结果。
Second-line treatment outcomes after progression from first-line chemotherapy plus immunotherapy in patients with advanced non-small cell lung cancer.
发表日期：2023 Feb 04
作者：
Edouard Auclin, Jose Benitez-Montanez, Marco Tagliamento, Francesca Parisi, Teresa Gorria, Rosario Garcia-Campelo, Naomi Dempsey, David J Pinato, Roxana Reyes, Víctor Albarrán-Artahona, Filippo Dall'Olio, Davide Soldato, Lizza Hendriks, Frank Aboubakar Nana, Marion Tonneau, Rafael Lopez-Castro, Ernest Nadal, Suzanne Kazandjian, Thierry Muanza, Félix Blanc-Durand, Elizabeth Fabre, Natalia Castro, Hugo Arasanz, Adrien Rochand, Benjamin Besse, Bertrand Routy, Laura Mezquita
来源：
LUNG CANCER
摘要：
化疗加免疫治疗是治疗转移性非小细胞肺癌患者的标准。目前尚无研究评估在一线化疗免疫治疗后进展后二线化疗的疗效。本多中心回顾性研究评估了进展后二线（2L）化疗在一线（1L）化疗免疫治疗下的疗效，包括总生存期（2L-OS）和无进展生存期（2L-PFS）。总共包括124名患者，平均年龄为63.1岁，其中30.6％为女性，72.6％的患者是腺癌，43.5％的患者在开始二线治疗之前具有不良的ECOG表现状态。64名患者（52.0％）对一线化疗免疫治疗产生了抵抗性（1L-PFS＜6个月）。在二线治疗中，57名（46.0％）患者接受了紫杉烷单药治疗，25名（20.1％）接受了紫杉烷和抗血管生成药物治疗，12名（9.7％）接受了基于铂的化疗，30名（24.2％）接受了其他化疗。在随访时间的中位数为8.3个月（95％CI：7.2-10.2）时，开始二线治疗后，中位2L-OS为8.1个月（95％CI：6.4-12.7），中位2L-PFS为2.9个月（95％CI：2.4-3.3）。总体而言，2L目标反应率和2L疾病控制率分别为16.0％和42.5％。紫杉烷和抗血管生成药物和铂类二线治疗实现了最长的中位2L-OS：分别为未达到（95％CI：5.8-NR）和17.6个月（95％CI 11.6-NR）（p = 0.05）。与1L应答者相比，1L抗性患者的预后较差（2L-OS 5.1个月，2L-PFS 2.3个月）。在这个现实生活的队列中，二线化疗在化疗免疫治疗进展后取得了适度的活性。1L抵抗患者仍然是难以治疗的人群，强调了需要新的二线策略。版权所有©2023 Elsevier B.V.
Chemotherapy plus immunotherapy is the standard of care for patients with metastatic NSCLC. No study has evaluated the outcomes of second-line chemotherapy treatments after progression following first-line chemo-immunotherapy.This multicenter retrospective study evaluated the efficacy of second line (2L) chemotherapies after progression under first-line (1L) chemo-immunotherapy, measured by overall survival (2L-OS) and progression free survival (2L-PFS).A total of 124 patients were included. The mean age was 63.1 years, 30.6 % of the patients were female, 72.6 % had an adenocarcinoma and 43.5 % had a poor ECOG-performance status prior to 2L initiation. Sixty-four (52.0 %) patients were considered resistant to first line chemo-immunotherapy. (1L-PFS < 6 months). In 2L treatments, 57 (46.0 %) patients received taxane monotherapy, 25 (20.1 %) taxane plus anti-angiogenic, 12 (9.7 %) platinum-based chemotherapy and 30 (24.2 %) other chemotherapy. At a median follow-up of 8.3 months (95 %CI: 7.2-10.2), post initiation of 2L treatment, the median 2L-OS was 8.1 months (95 % CI: 6.4-12.7) and the median 2L-PFS was 2.9 months (95 %CI: 2.4-3.3). Overall, the 2L-objective response and 2L-disease control rates were 16.0 %, and 42.5 %, respectively. Taxane plus anti-angiogenic and platinum rechallenge achieved longest median 2L-OS: not reached (95 %CI: 5.8-NR) and 17.6 months (95 %CI 11.6-NR), respectively (p = 0.05). Patients resistant to the 1L treatment had inferior outcomes (2L-OS 5.1 months, 2L-PFS 2.3 months) compared with 1L responders (2L-OS 12.7 months, 2L-PFS 3.2 months).In this real-life cohort, 2L chemotherapy achieved modest activity following progression under chemo-immunotherapy. 1L-resistant patients remained a refractory population, highlighting a need for new 2L strategies.Copyright © 2023. Published by Elsevier B.V.